Apple Health (Medicaid): Fee-for-service Preferred Drug List (PDL)

Washington State Health Care Authority sent this bulletin at 04/28/2017 03:55 PM PDT

Apple Health (Medicaid): Provider Alert

Dear Provider,

Effective for claims with dates of service on and after June 1, 2017, the Health Care Authority (agency) will make the following changes to the Apple Health (Medicaid): Fee-for- Service Preferred Drug List (PDL):

Drug Class

Drug Name

Change

Diabetes Drugs -- SGLT-2 Inhibitors

Synjardy XR®

Added as Non-Preferred, not subject to TIP/DAW-1 override.

Multiple Sclerosis

Ocrevus®

Added as Non-Preferred, subject to DAW-1 override.

NSAIDs

Entire class

Client must try all preferred drugs before a non-preferred drug will be authorized unless contraindicated or not clinically appropriate.

Skeletal Muscle Relaxants

Entire class

Client must try all preferred drugs before a non-preferred drug will be authorized unless contraindicated or not clinically appropriate.